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BACKGROUND: Diabetes prevalence ranges from 8.9% in central Texas to 19.5% in south Texas. The Texas Diabetes Program supports 11 Community Diabetes Projects (CDPs) located throughout the state to provide a series of lifestyle and disease management classes to high-risk populations to improve their health outcomes. The aim of this study was to examine average extrapolated changes in clinical health indicators by demographics and diabetes status among participants of CDP interventions.
METHODS: One or more times during a class series (1 class per week, 4 to 8 classes per series), participants self-reported demographics, health history, and health behaviors. CDP staff measured Body Mass Index (BMI), Systolic Blood Pressure (SBP), and waist circumference. A1C was measured by a health clinic associated with the CDP site or provided from recent blood work. Analyses were restricted to adults participating in any series on diabetes self-management education, nutrition, or physical activity from October 3, 2011 to November 5, 2013 with accurate date of birth and two or more information sheets completed on different days. To evaluate health outcome changes over time, linear mixed effects models were used to calculate the average change per visit in each health indicator (BMI, SBP, waist circumference, and A1C) stratified by sex, age, race/ethnicity, and diabetes status. To estimate health indicator values after six class visits, the average change was multiplied by six and added to the baseline average. Analyses were conducted with Stata 13.0.
RESULTS: 906 participants met the inclusion criteria among whom 2,056 visits were captured. At baseline, most participants were over age 55 (55.9%), female (80.5%), Hispanic/Latino (63.7%), obese (59.8%), had diabetes (53.0%), and a family history of diabetes (62.0%). All statistically significant linear mixed effects models showed an inverse relationship between number of class visits and clinical health measures (indicating improvement). Overall, significant decreases from baseline to extrapolated averages were observed for SBP (128.9mmHg to 116.0mmHg), waist circumference among females (101.3cm to 95.1cm), and A1C (6.8% to 6.3%). SBP decreased significantly among all groups except age 55-64 years. Notably, average SBP decreased from baseline to extrapolated value among participants over age 65 (138.4mmHg to 114.2mmHg), African Americans (128.1mmHg to 118.3mmHg), persons with diabetes (133.5mmHg to 119.4mmHg) and without diabetes (126.4mmHg to 115.1mmHg).
CONCLUSIONS: Participants reported significant improvements in short-term clinical outcomes such as SBP, waist circumference, and A1C. Expanding the reach of the diabetes education and lifestyle interventions may be an effective way to improve diabetes outcomes in Texas.